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Hi Everybody,

Welcome to the Nourish Balance Thrive highlights!

This week I’ve been thinking about tribalism in health again. I come back to this topic frequently because I see good in what every different group is trying to achieve in health, even while they’re busy taking pot shots at other health groups with different views. Though I have an approach that I believe to be the best that I am currently capable of, I also believe that there are thousands of coaches and health practitioners doing fabulous work to improve people’s health by using methods that are completely different (and perhaps even contradictory) to my own.

Two weeks ago this paper described a pretty bleak picture of metabolic health in the US (and I’m pretty sure many other countries are rapidly catching up). Using biochemical data from nearly 9,000 people, who were selected to be roughly representative of the general US population, the researchers applied fairly strict criteria to determine what proportion of adults had good metabolic health. Though we could perhaps debate and improve upon their definitions, the criteria they used were stricter than what is currently in most national guidelines. They defined metabolic health as having:

  • A waist circumference <102cm (40in) in men, or <88cm (34.5in) in women

  • Fasting glucose <100 mg/dl (5.5mM) and hemoglobin A1c <5.7% (39mmol/mol)

  • Blood pressure <120/80 mmHg

  • Triglycerides <150 mg/dl (1.7mM)

  • HDL cholesterol ≥40mg/dl (1.0mM) in men and ≥50mg/dl (1.3mM) in women

  • Not taking medications that affect any of the above

Based on these criteria, just 12.2% of the study population had good metabolic health. Based on how we calculate health, this number is probably only going to decrease across the whole population. This is a staggering number of people - potentially more than 200 million in the US alone - who have markers of disease that are pretty uniformly associated with environmental factors.

How does this link back to tribalism in health? Simply due to the fact that there are so many people who could benefit from being empowered to improve their health by altering their environment that no single approach and no single person or group is going to be able to engage, educate, or inspire them all. Much as everybody has a different background and view of the world, as will everybody have a different type of method or approach that will speak to them. Maybe it’s through a plant-based diet, or a ketogenic diet. Maybe it’s paleo or carnivore. Maybe it’s calorie counting. Or maybe it’s through a specific religion or spiritual practice. Maybe it’s CrossFit. Maybe it’s through a focus on a single action or factor that doesn’t explain the nuances and variability of human physiology, but gets the job done anyway. All of these approaches are important because they can provide inspiration and education to different groups of people.

This week Dr. Siddhartha Mukherjee wrote an article entitled “It’s Time to Study Whether Eating Particular Diets Can Help Heal Us”. Of course, I think pretty much everybody reading this agrees that diet changes can help to both prevent and reverse disease; however, seeing it from the point of cancer treatment from somebody so well connected is an important step!

In the article, Dr. Mukherjee talks about a set of mouse studies he was part of which found that a ketogenic diet helped to increase the efficacy of PI3K inhibitors for the treatment of certain tumours. However, the ketogenic diet alone also accelerated leukaemia implanted into mice. As a result of the study he had people on social media tell him both that “keto is pure hype” and that he was “undermining the effectiveness of the ketogenic diet in cancer”. So the process of presenting high-quality data showing how tricky it can be to use diet as a strategy for cancer treatment essentially enraged people who were both for and against ketogenic diets!

Though I understand where the sentiments come from, I would suggest that these shots thrown from afar on social media are at best useless and at worst potentially harmful. While dietary approaches for cancer (and other diseases) are being rigorously tested in animal and human studies, we should commend the scientists trying to figure that out. At the same time, those of us trying to make the best of the information we already have to help others should also support one-another, even if we end up having differences in opinion on how to do that.

A big part of my job is parsing through health information to figure out what might work best, and helping others to do the same. However, I don’t believe that any one of us has all the answers. I also believe that we’re all on the same side as we try to help others with their health, and more often than not a person we disagree with is also doing what they think is best.

It’s important to note that approaches and systems can always improve. But in the meantime, the upshot is that if you’re using any lifestyle intervention that is objectively working to empower people to become healthier, you have my unwavering support, regardless of how you do it. Considering the huge number of people that could benefit from lifestyle changes, there is also huge scope in the range of approaches that could help.

Finally, I would recommend that anybody reading this take a moment to think about their next interaction on social media. Instead of trying to enforce your opinion on somebody else, why not take the time to acknowledge the work they are doing and how important it is, regardless of whether you agree on the details. When it comes to lifestyle interventions for disease treatment, what unites us should be far greater than what divides us. And the health of literally millions of people depends on that.

Thanks for reading, and have a great week!

Tommy Wood MD, PhD

Copyright © 2018 Nourish Balance Thrive, All rights reserved.

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